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      The effect of tiotropium/olodaterol versus fluticasone propionate/salmeterol on left ventricular filling and lung hyperinflation in patients with COPD

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          Abstract

          This exploratory, randomised, double-blind, double-dummy, multicentre, cross-over study explored the effect of 6 weeks of treatment with tiotropium/olodaterol (T/O) versus fluticasone propionate/salmeterol (F/S) on left ventricular filling in patients with chronic obstructive pulmonary disease with functional residual capacity (FRC) >120% predicted and postbronchodilator improvement of FRC ≥7.5%. Overall, 76 patients were randomised across nine sites. Treatment with T/O or F/S increased left ventricular end-diastolic volume index from baseline (adjusted mean change: T/O: 2.317 mL/m 2, F/S: 2.855 mL/m 2), with no statistically significant difference between treatments. However, T/O resulted in a significantly greater reduction in lung hyperinflation versus F/S (FRC plethysmography absolute change from baseline: F/S: –0.329 L, T/O: –0.581 L).

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          Standardisation of the measurement of lung volumes.

          J Wanger, J. L. Clausen, A. Coates … (2005)
          Article 0 comments Cited 325 times – based on 0 reviews     Review now
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            Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study.

            Martin Claussen, C. Boehme, Helgo Magnussen … (2008)
            Physical activity is reduced in patients with chronic obstructive pulmonary disease (COPD). COPD has a systemic component that includes significant extrapulmonary effects that may contribute to its severity in individual patients. To investigate the association of extrapulmonary effects of the disease and its comorbidities with reduced physical activity in patients with COPD. In a cross-sectional study, 170 outpatients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages I-IV; BODE [body mass index, airway obstruction, dyspnea, and exercise capacity] score 0-10) underwent a series of tests. Physical activity was assessed over 5 to 6 consecutive days by using a multisensor accelerometer armband that records steps per day and the physical activity level (total daily energy expenditure divided by whole-night sleeping energy expenditure). Cardiovascular status was assessed by echocardiography, vascular Doppler sonography, and levels of N-terminal pro-B-type natriuretic peptide. Mental status, metabolic/muscular status, systemic inflammation, and anemia were assessed by Beck Depression Inventory, bioelectrical impedance analysis, handgrip strength, high-sensitivity C-reactive protein/fibrinogen, and hemoglobin, respectively. In a multivariate linear regression analysis using either steps per day or physical activity level as a dependent variable, the extrapulmonary parameters that were associated with reduced physical activity in patients with COPD independently of GOLD stages or BODE score were N-terminal pro-B-type natriuretic peptide levels, echocardiographically measured left ventricular diastolic function, and systemic inflammation. Higher values of systemic inflammation and left cardiac dysfunction are associated with reduced physical activity in patients with COPD.
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              Cardiovascular disease and COPD: dangerous liaisons?

              Klaus F. Rabe, John R. Hurst, Samy Suissa (2018)
              Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together and their coexistence is associated with worse outcomes than either condition alone. Pathophysiological links between COPD and CVD include lung hyperinflation, systemic inflammation and COPD exacerbations. COPD treatments may produce beneficial cardiovascular (CV) effects, such as long-acting bronchodilators, which are associated with improvements in arterial stiffness, pulmonary vasoconstriction, and cardiac function. However, data are limited regarding whether these translate into benefits in CV outcomes. Some studies have suggested that treatment with long-acting β 2 -agonists and long-acting muscarinic antagonists leads to an increase in the risk of CV events, particularly at treatment initiation, although the safety profile of these agents with prolonged use appears reassuring. Some CV medications may have a beneficial impact on COPD outcomes, but there have been concerns about β-blocker use leading to bronchospasm in COPD, which may result in patients not receiving guideline-recommended treatment. However, there are few data suggesting harm with these agents and patients should not be denied β-blockers if required. Clearer recommendations are necessary regarding the identification and management of comorbid CVD in patients with COPD in order to facilitate early intervention and appropriate treatment. CVD and COPD are often comorbid. Their pathophysiology and treatment may affect each other and health outcomes. http://ow.ly/v18p30lxmms
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Respir Res
                Journal ID (iso-abbrev): BMJ Open Respir Res
                Journal ID (hwp): bmjresp
                Journal ID (publisher-id): bmjopenrespres
                Title: BMJ Open Respiratory Research
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2052-4439
                Publication date Collection: 2020
                Publication date (Electronic): 2 December 2020
                Volume: 7
                Issue: 1
                Electronic Location Identifier: e000741
                Affiliations
                [1 ]departmentDepartment of Pneumology and Critical Care Medicine , Thoraxklinik–Heidelberg GmbH, Translational Lung Research Center Heidelberg (TLRC) , Heidelberg, Germany
                [2 ]departmentBiomedical Research in Endstage and Obstructive Lung Disease (BREATH) , Fraunhofer Institute for Toxicology and Experimental Medicine ITEM , Hannover, Germany
                [3 ]departmentDepartment of Respiratory Medicine , Hannover Medical School , Hannover, Germany
                [4 ]CIMS Studienzentrum Bamberg GmbH , Bamberg, Germany
                [5 ]departmentTA CardioMetabolism Respiratory Medicine , Boehringer Ingelheim International GmbH , Ingelheim am Rhein, Germany
                [6 ]Boehringer Ingelheim Pharmaceuticals Inc , Ridgefield, Connecticut, USA
                [7 ]departmentDepartment of Radiology , Johannes Gutenberg University , Mainz, Germany
                [8 ]departmentDepartment of Medicine, Pulmonary and Critical Care Medicine , University Medical Center Giessen and Marburg , Marburg, Germany
                [9 ]departmentDepartment of Diagnostic and Interventional Radiology , Hannover Medical School , Hannover, Germany
                [10 ]departmentPulmonary Research Institute , LungenClinic Grosshansdorf GmbH, Airway Research Centre North (ARCN) , Grosshansdorf, Germany
                Author notes
                [Correspondence to ] Professor Felix Herth; felix.herth@ 123456med.uni-heidelberg.de
                Article
                Publisher ID: bmjresp-2020-000741
                DOI: 10.1136/bmjresp-2020-000741
                PMC ID: 7713210
                PubMed ID: 33268341
                SO-VID: c92ddecf-b1f4-4525-9788-27f4bcc560e9
                Copyright © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 18 August 2020
                Date revision received : 06 November 2020
                Date accepted : 06 November 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100001003, Boehringer Ingelheim;
                Award ID: N/A
                Categories
                Subject: Perspective
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: copd pharmacology,inhaler devices,respiratory measurement
                Data availability:
                Keywords: copd pharmacology, inhaler devices, respiratory measurement

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